Purpose:
To explore the experiences of cataract surgeons in managing patients with dementia; their expectations, decision making processes and the challenges they may face.

Methods:
A qualitative study using semi-structured interviews of senior cataract surgeons from two centers in the North-East of England. A total of 14 surgeons were interviewed and a thematic approach, informed by grounded theory was used to analyse the data.

Results:
Central issues emerging from the research included consent and choice of anesthesia with the associated challenges of assessing patients with dementia within the eye clinic. In the UK, decisions surrounding consent and capacity are governed by the Mental Capacity Act (2005) and Mental Health Act (2007). Whilst most surgeons had some knowledge of this legislation, they did not generally see consent for people with dementia as a contentious issue and claimed to use a pragmatic, common-sense approach involving family members. The required legal procedures and form-filling were often seen as an inconvenience and as being more relevant for patients undergoing major, life-threatening surgery. Surgeons varied in their thresholds for using general anesthesia and their use of sedation. Some surgeons had negative experiences of using local anesthesia for patients who could subsequently not tolerate it and surgery had to be abandoned. Decisions about suitability for local anesthesia and capacity to consent were limited by time constraints and generally made rapidly and based on instinct.

Conclusions:
We have identified some of the key challenges facing cataract surgeons caring for people with dementia. Consent procedures need to be specifically tailored for cataract surgery and additional time and support is needed for surgeons as they make complex decisions over anesthetic choices and capacity to consent.